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Famiial H5N1 Cluster in Lampung Indonesia Confirmed
October 24, 2005
The first newly confirmed case is a four-year-old boy from Sumatra Island in Lampung Province. He developed symptoms on 4 October, was hospitalized, recovered fully, and has returned home.
This case is the nephew of the 21-year-old man from Lampung, who was reported on 10 October 2005. Although the two cases are related and lived in the same neighbourhood, human-to-human transmission is considered unlikely.
The above comments from the WHO report give no reason why human-to-human transmission is unlikely. The uncle was admitted September 24, so the development of symptoms in his nephew 10 days later would suggest human-to-human transmission. Moreover, the brother/nephew of the uncle was also admitted with bird flu symptoms on September 25. He too quickly recovered and was discharged, but the H5N1 tests were negative so he was diagnosed with typhus. Since he had two relatives that were PCR H5N1 confirmed, it is likely that the third family member was also infected.
Thus, most of the confirmed H5N1 cases in Indonesia belong to family clusters with at least one additional family member laboratory confirmed for H5N1.
The first case in Indonesia was part of a three person cluster. Both of his daughters died with bird flu symptoms and his oldest daughter, the index case, had high titers against H5N1 in two serum samples.
The second and third cases in Indonesia were aunt and nephew, again suggesting human-to-human transmission. The nephew also had a mild case, recovered and was discharged.
The two cases discussed above were also part of a familial cluster. Thus, only two of the seven confirmed H5N1 cases were not part of a familial cluster.
The two most recent confirmed cases tested PCR positive in Jakarta. Thus, all PCR positive cases in Jakarta have been confirmed by Hong Kong.
The high frequency of these cases in familial clusters is cause for concerns that are not alleviated by WHO unsupported proclamations of unlikely human-to-human transmission.